Collective evaluation in specialised medical consultations
The co-construction of the diagnostic object
DOI:
https://doi.org/10.1558/japl.26898Keywords:
assessment, co-construction of diagnostic objects, conversational analysis, multimodality, prosthesis choice and application, shared professional visionAbstract
This article investigates 50 specialised medical consultations conducted by a team of practitioners at a prosthetics centre. Specifically, the article focuses on evaluation sequences in which practitioners collectively assess the conditions of amputee patients by observing changing positions and various portions of their limbs (stumps), in order to choose the best prosthetic device for them. In so doing, practitioners participate in the construction of a shared diagnostic object (the assessable), a process that is crucial in the evaluation sequence and key to understanding the interactional practices whereby the participants transform the patient’s limb(s) into a professional case to be processed in the following clinical phases. In particular, what emerges is a shared professional vision upon which all subsequent decision-making rests. This vision is achieved through specific tacit practices reflecting the interplay of various territories of knowledge and building a professional backstage from which the patient is temporarily excluded.
References
Atkinson, P. (1995) Medical Talk and Medical Work. London: Sage.
Atkinson, P. (2004) The discursive construction of competence and responsibility in medical collegial talk. Communication and Medicine 1 (1): 13–23. https://doi.org/10.1515/come.2004.001
Beach W. A. (ed.) (2013) Handbook of Patient-Provider Interactions: Raising and Responding to Concerns about Life, Illness, & Disease. New York: Hampton Press.
Caronia, L., Chieregato, A. and Saglietti, M. (2017) Assembling (non) treatable cases: The communicative constitution of medical object in doctor-doctor interaction. Discourse Studies 19 (1): 30–48. https://doi.org/10.1177/1461445616683594
Eriksson, M. (2008) Referring as interaction: On the interplay between linguistic and bodily practices. Journal of Pragmatics 41 (2): 240–262. https://doi.org/10.1016/j.pragma.2008.10.011
Fasulo, A. and Monzoni, C. (2009) Assessing mutable objects: A multimodal analysis. Research on Language and Social Interaction 42 (4): 362–376. https://doi.org/10.1080/08351810903296481
Galatolo, R. and Margutti, P. (2016) Territories of knowledge, professional identities and patients’ participation in specialized visits with a team of practitioners. Patient Education and Counseling 99 (6): 888–896. https://doi.org/10.1016/j.pec.2015.11.010
Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania Press.
Goodwin, C. (1994) Professional vision. American Anthropologist 96 (3): 606–633. https://doi.org/10.1525/aa.1994.96.3.02a00100
Goodwin, C. (1997) The blackness of black: Color categories as situated practice. In L. Resnick, R. Säljö, C. Pontecorvo and B. Burge (eds) Discourse, Tools and Reasoning: Essays on Situated Cognition, 111–140. New York: Springer.
Goodwin, C. (2003) Pointing as situated practice. In S. Kita (ed.) Pointing: Where Language, Culture and Cognition Meet, 217–241. Mahwah, NJ: Lawrence Erlbaum.
Goodwin, C. and Goodwin, M. H. (1987) Concurrent operations on talk: Notes on the interactive organizations of assessments. IPrA papers in Pragmatics 1 (1): 1–54. https://doi.org/10.1075/iprapip.1.1.01goo
Goodwin, D., Pope, C., Mort, M. and Smith, A. (2005) Access, boundaries and their effects: Legitimate participation in anaesthesia. Sociology of Health & Illness 27 (6): 855–871. https://doi.org/10.1111/j.1467-9566.2005.00477.x
Haddington, P. (2006) The organization of gaze and assessments as resources for stance taking. Text & Talk 23 (6): 281–328. https://doi.org/10.1515/TEXT.2006.012
Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. C. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 185–213. Cambridge: Cambridge University Press.
Heritage, J. C., Elliot, M. N., Stivers, T., Richardson, A. and Mangione-Smith, R. (2010) Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings. Patient Education and Counseling 81 (1): 119–125. https://doi.org/10.1016/j.pec.2009.12.005
Heritage, J. C. and Maynard, D. W. (eds) (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.
Heritage, J. C. and Raymond, G. (2005) The terms of agreement: Indexing epistemic authority and subordination in talk-in-interaction. Social Psychology Quarterly 68 (1): 15–38. https://doi.org/10.1177/019027250506800103
Heritage, J. C. and Stivers, T. (1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science & Medicine 49 (11): 1501–1517. https://doi.org/10.1016/S0277-9536(99)00219-1
Heritage, J. C. and Watson, R. (1979) Formulations as conversational objects. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 123–161. New York: Erlbaum.
Hindmarsh J. and Pilnick, A. (2002) The tacit order of teamwork: Collaboration and embodied conduct in anesthesia. Sociological Quarterly 43 (2): 139–164. https://doi.org/10.1111/j.1533-8525.2002.tb00044.x
Hindmarsh, J. and Pilnick, A. (2007) Knowing bodies at work: Embodiment and ephemeral teamwork in anaesthesia. Organization Studies 28 (9): 1395–1416. https://doi.org/10.1177/0170840607068258
Jefferson, G. (1984) Transcription notation. In J. M. Atkinson and J. C. Heritage (eds) Structures of Social Action: Studies in Conversation Analysis, ix–xvi. Cambridge: Cambridge University Press.
Kidwell, M. and Zimmerman D. H. (2007) Joint attention as action. Journal of Pragmatics 39 (3): 592–611. https://doi.org/10.1016/j.pragma.2006.07.012
Koschmann, T., LeBaron, C., Goodwin, C., Zemel, A. and Dunnington, G. (2007) Formulating the triangle of doom. Gesture 7 (1): 97–118. https://doi.org/10.1075/gest.7.1.06kos
Mangione-Smith, R., Stivers, T., Elliott, M. N., McDonald, L. and Heritage, J. (2003) Online commentary during the physical examination: A communication tool for avoiding inappropriate antibiotic prescribing? Social Science & Medicine 56 (2): 313–320. https://doi.org/10.1016/S0277-9536(02)00029-1
Mondada, L. (2009) The embodied and negotiated production of assessments in instructed actions. Research on Language and Social Interaction 42 (4): 329–360. https://doi.org/10.1080/08351810903296473
Pomerantz, A. (1984) Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shapes. In J. M. Atkinson and J. C. Heritage (eds) Structures of Social Action: Studies in Conversation Analysis, 57–101. Cambridge: Cambridge University Press.
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–59. https://doi.org/10.1207/S15327027HC1501_2
Ruusuvuori, J. and Peräkylä, A. (2009) Facial and verbal expressions in assessing stories and topics. Research on Language and Social Interaction 42 (4): 377–394. https://doi.org/10.1080/08351810903296499
Sanchez Svensson, M., Luff, P. and Heath, C. (2009) Embedding instruction in practice: Contingency and collaboration during surgical training. In A. Pilnick, J. Hindmarsh and V. T. Gill (eds) Communication in Healthcare Settings: Policy, Participation and New Technologies, 99–116. Oxford: Wiley-Blackwell.
Schegloff, E. A. (1972) Notes on a conversational practice: Formulating place. In D. Sudnow (ed.) Studies in Social Interaction, 75–119. New York: Free Press.
Sidnell, J. and Stivers, T. (eds) (2005) Multimodal Interaction. Special issue of Semiotica 156.
Atkinson, P. (2004) The discursive construction of competence and responsibility in medical collegial talk. Communication and Medicine 1 (1): 13–23. https://doi.org/10.1515/come.2004.001
Beach W. A. (ed.) (2013) Handbook of Patient-Provider Interactions: Raising and Responding to Concerns about Life, Illness, & Disease. New York: Hampton Press.
Caronia, L., Chieregato, A. and Saglietti, M. (2017) Assembling (non) treatable cases: The communicative constitution of medical object in doctor-doctor interaction. Discourse Studies 19 (1): 30–48. https://doi.org/10.1177/1461445616683594
Eriksson, M. (2008) Referring as interaction: On the interplay between linguistic and bodily practices. Journal of Pragmatics 41 (2): 240–262. https://doi.org/10.1016/j.pragma.2008.10.011
Fasulo, A. and Monzoni, C. (2009) Assessing mutable objects: A multimodal analysis. Research on Language and Social Interaction 42 (4): 362–376. https://doi.org/10.1080/08351810903296481
Galatolo, R. and Margutti, P. (2016) Territories of knowledge, professional identities and patients’ participation in specialized visits with a team of practitioners. Patient Education and Counseling 99 (6): 888–896. https://doi.org/10.1016/j.pec.2015.11.010
Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania Press.
Goodwin, C. (1994) Professional vision. American Anthropologist 96 (3): 606–633. https://doi.org/10.1525/aa.1994.96.3.02a00100
Goodwin, C. (1997) The blackness of black: Color categories as situated practice. In L. Resnick, R. Säljö, C. Pontecorvo and B. Burge (eds) Discourse, Tools and Reasoning: Essays on Situated Cognition, 111–140. New York: Springer.
Goodwin, C. (2003) Pointing as situated practice. In S. Kita (ed.) Pointing: Where Language, Culture and Cognition Meet, 217–241. Mahwah, NJ: Lawrence Erlbaum.
Goodwin, C. and Goodwin, M. H. (1987) Concurrent operations on talk: Notes on the interactive organizations of assessments. IPrA papers in Pragmatics 1 (1): 1–54. https://doi.org/10.1075/iprapip.1.1.01goo
Goodwin, D., Pope, C., Mort, M. and Smith, A. (2005) Access, boundaries and their effects: Legitimate participation in anaesthesia. Sociology of Health & Illness 27 (6): 855–871. https://doi.org/10.1111/j.1467-9566.2005.00477.x
Haddington, P. (2006) The organization of gaze and assessments as resources for stance taking. Text & Talk 23 (6): 281–328. https://doi.org/10.1515/TEXT.2006.012
Heath, C. (2006) Body work: The collaborative production of the clinical object. In J. C. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 185–213. Cambridge: Cambridge University Press.
Heritage, J. C., Elliot, M. N., Stivers, T., Richardson, A. and Mangione-Smith, R. (2010) Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings. Patient Education and Counseling 81 (1): 119–125. https://doi.org/10.1016/j.pec.2009.12.005
Heritage, J. C. and Maynard, D. W. (eds) (2006) Communication in Medical Care: Interaction between Primary Care Physicians and Patients. Cambridge: Cambridge University Press.
Heritage, J. C. and Raymond, G. (2005) The terms of agreement: Indexing epistemic authority and subordination in talk-in-interaction. Social Psychology Quarterly 68 (1): 15–38. https://doi.org/10.1177/019027250506800103
Heritage, J. C. and Stivers, T. (1999) Online commentary in acute medical visits: A method of shaping patient expectations. Social Science & Medicine 49 (11): 1501–1517. https://doi.org/10.1016/S0277-9536(99)00219-1
Heritage, J. C. and Watson, R. (1979) Formulations as conversational objects. In G. Psathas (ed.) Everyday Language: Studies in Ethnomethodology, 123–161. New York: Erlbaum.
Hindmarsh J. and Pilnick, A. (2002) The tacit order of teamwork: Collaboration and embodied conduct in anesthesia. Sociological Quarterly 43 (2): 139–164. https://doi.org/10.1111/j.1533-8525.2002.tb00044.x
Hindmarsh, J. and Pilnick, A. (2007) Knowing bodies at work: Embodiment and ephemeral teamwork in anaesthesia. Organization Studies 28 (9): 1395–1416. https://doi.org/10.1177/0170840607068258
Jefferson, G. (1984) Transcription notation. In J. M. Atkinson and J. C. Heritage (eds) Structures of Social Action: Studies in Conversation Analysis, ix–xvi. Cambridge: Cambridge University Press.
Kidwell, M. and Zimmerman D. H. (2007) Joint attention as action. Journal of Pragmatics 39 (3): 592–611. https://doi.org/10.1016/j.pragma.2006.07.012
Koschmann, T., LeBaron, C., Goodwin, C., Zemel, A. and Dunnington, G. (2007) Formulating the triangle of doom. Gesture 7 (1): 97–118. https://doi.org/10.1075/gest.7.1.06kos
Mangione-Smith, R., Stivers, T., Elliott, M. N., McDonald, L. and Heritage, J. (2003) Online commentary during the physical examination: A communication tool for avoiding inappropriate antibiotic prescribing? Social Science & Medicine 56 (2): 313–320. https://doi.org/10.1016/S0277-9536(02)00029-1
Mondada, L. (2009) The embodied and negotiated production of assessments in instructed actions. Research on Language and Social Interaction 42 (4): 329–360. https://doi.org/10.1080/08351810903296473
Pomerantz, A. (1984) Agreeing and disagreeing with assessments: Some features of preferred/dispreferred turn shapes. In J. M. Atkinson and J. C. Heritage (eds) Structures of Social Action: Studies in Conversation Analysis, 57–101. Cambridge: Cambridge University Press.
Robinson, J. D. (2003) An interactional structure of medical activities during acute visits and its implications for patients’ participation. Health Communication 15 (1): 27–59. https://doi.org/10.1207/S15327027HC1501_2
Ruusuvuori, J. and Peräkylä, A. (2009) Facial and verbal expressions in assessing stories and topics. Research on Language and Social Interaction 42 (4): 377–394. https://doi.org/10.1080/08351810903296499
Sanchez Svensson, M., Luff, P. and Heath, C. (2009) Embedding instruction in practice: Contingency and collaboration during surgical training. In A. Pilnick, J. Hindmarsh and V. T. Gill (eds) Communication in Healthcare Settings: Policy, Participation and New Technologies, 99–116. Oxford: Wiley-Blackwell.
Schegloff, E. A. (1972) Notes on a conversational practice: Formulating place. In D. Sudnow (ed.) Studies in Social Interaction, 75–119. New York: Free Press.
Sidnell, J. and Stivers, T. (eds) (2005) Multimodal Interaction. Special issue of Semiotica 156.
Published
2017-12-12
Issue
Section
Articles
License
Equinox Publishing Ltd.
How to Cite
Galatolo, R., & Cirillo, L. (2017). Collective evaluation in specialised medical consultations: The co-construction of the diagnostic object. Journal of Applied Linguistics and Professional Practice, 10(3), 337-360. https://doi.org/10.1558/japl.26898
